This paper addresses six foundational topics in public health practice. It examines the factors driving public health's resurgence over the past two decades, including vaccination, hygiene, and epidemiology. The paper analyzes the ethical failures of the Tuskegee Syphilis Study, outlines the three types of law and their relevance to public health agencies, and explains how Section 1983 of the Civil Rights Act applies to public health officials. It also describes surveillance strategies for E. coli, spinal cord injury, and lung cancer among nonsmokers, and concludes by arguing for an asset-based approach to community health assessment and program planning.
Many factors have contributed to the renaissance of public health over the past 20 years. The most important include the eradication of infectious diseases through vaccination, increased public awareness, better hygiene control, improved primary care facilities, and greater emphasis on epidemiology.
It has been stated that humans have a right to public health (Principles of the Ethical Practice of Public Health, 2002). With this in mind, public health authorities have been quite vigilant in reducing the burden of disease. Infectious diseases were once the major cause of morbidity and mortality, but through the availability of vaccines and antibiotics, these diseases have been controlled to a significant extent. Vaccination programs protecting against tuberculosis, diphtheria, pertussis, mumps, measles, and rubella have achieved success in countries around the world. Antibiotics have also become available to treat infectious diseases such as diarrhea and upper respiratory tract infections.
Community awareness has been enhanced so that individuals contribute to improving their own health. For instance, hygiene has been improved by stressing the importance of handwashing. In countries where safe drinking water is not available, filtration plants have been established to minimize waterborne diseases. A great deal of emphasis has also been placed on epidemiology. The modern-day epidemic centers on cardiovascular and cerebrovascular disease, and researchers and epidemiologists have shifted their focus accordingly. The results of this research are being used to inform people about the risks of overeating and a sedentary lifestyle. Finally, primary care has been made accessible even in the most remote areas of the world.
For a period of 40 years, doctors and public officials watched 400 men die in an experiment about syphilis. This study was carried out on immoral and unethical grounds for the sole purpose of studying the disease in greater detail. The people included in the study were never informed that they were participants. Furthermore, available treatment options for syphilis were deliberately withheld from them. The doctors effectively prevented these men from seeing physicians who could have helped them. As a result, many died painful deaths, others became mentally ill or permanently blind, and the disease was transmitted to their children as well.
This study was unethical for several reasons. Most fundamentally, the men were never informed about what they were being subjected to, meaning that no consent was ever obtained from them. The Code of Ethical Practice states that public health institutions should obtain a community's consent before any program is implemented (Thomas & Sage et al., 2002). Another provision of that code holds that programs and policies should be designed in ways that enhance both the physical and social environment. The Tuskegee Syphilis Study deliberately overlooked the harmful effects of syphilis by focusing on the disease's later stages. While syphilis was a serious community health problem at the time, that reality did not justify the immoral treatment of the study participants. Most critically, the study violated the first principle of public health: to prevent adverse health outcomes. Withholding treatment from patients is not preventing adverse health outcomes. This study clearly violated the ethical, moral, and professional guidelines of the profession.
The three types of law are criminal law, constitutional law, and civil law (Schwarzenberger, 1943). Criminal law describes the actions that a person may not legally perform; in other words, it identifies which acts are legally wrong and thereby regulates conduct. Constitutional law identifies the consequences of crimes committed — in other words, it explains why a person is found guilty or why they receive a particular punishment. The most relevant type of law to public health is civil law, which concerns human association and the ways in which social functions are linked to the development and improvement of individuals within society (Schwarzenberger, 1943). It has been noted that people in a society must work together to succeed, yet also have the tendency to create conflict.
A public health agency must pay particular attention to civil law. In order to spread a health message or successfully implement a plan within a community, an agency must first understand that community — its interests, motivations, and aversions. These insights can be gained through knowledge of the applicable civil law. Because of differences in religion, culture, and social norms, no two communities are identical. Public health agencies must therefore learn how to interact with community members socially, economically, and medically. Agencies should strive to minimize disputes so that a meaningful level of trust can be established within the communities they serve.
Section 1983 of the Civil Rights Act enables a citizen to sue persons who, under color of state law, deprive them of their constitutional rights (Scutchfield & Keck, 1997). Violations of these rights carry relevant penalties for the offending party. Historically, this law could be applied to public health officials, with the government bearing responsibility for damages. In 1971, the U.S. Supreme Court allowed claims against individuals who violated rights in Bivens v. Six Unknown Named Agents of Federal Bureau of Narcotics, 403 U.S. 388 (1971). Following this decision, a legal mechanism known as a "Bivens action" emerged, through which this law could be applied to employees of the Public Health Service, the CDC, and other federal agencies.
This means that when a person working under a health department interacts with the public, they are personally liable for their own actions. Regardless of employment status, all such individuals — including volunteers — are responsible for how they treat patients and must be careful not to violate anyone's constitutional rights.
"Civil rights liability for public health employees"
"Surveillance strategies for three distinct conditions"
"Using community assets to improve health outcomes"
You’re 55% through this paper. Sign up to read the remaining 3 sections.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.